ANTIEPILEPTIC MEANS (antiepileptica) — the pharmaceuticals applied to treatment of epilepsy, and also other diseases proceeding with epileptic seizures.
By the pharmakoterapevtichesky principle pages distinguish drugs from P., effective is preferential at convulsive and convulsiveless attacks. Possess the expressed anticonvulsant action phenobarbital (see), a hexamidine (see), benzonal (see), dipheninum (see), clonazepam. Chloraconum and Methindionum have moderate anticonvulsant effect (see). Among the drugs stopping convulsiveless paroxysms the Ethosuximidum, Puphemidium and Morfolepum are most effective for treatment of patients with small attacks. At psychomotor attacks apply carbamazepine and Depakinum.
At generalized displays of epilepsy (see) barbiturates and clonazepam are effective. For stopping of the epileptic status parenterally enter diazepam (see).
Items of page are well soaked up in went. - kish. a path also have rather long effect, except for Methindionum which is quickly brought out of an organism.
The Kliniko-pharmakologichesky characteristic of the main P. of page is provided in the table.
The mechanism of action of P. of page, effective at convulsive attacks, comes down to the prevention of excess depolarization of neyronalny membranes that is caused by difficulty of receipt of ions of sodium in a cell or acceleration of their turn between a cell and the extracellular environment. Activation of neurons of convulsive focus is not caused. Restriction of depolarization of these processes in c. the N of page especially sharply affects function of internuncial neurons of projective ways that complicates distribution of convulsive categories. Weakening of neyronalny depolarization partly depends on P.'s ability of page to reduce the level of cyclic AMF in cells. The anticonvulsant effect of Valproatum of sodium is caused by increase of brake processes in connection with braking of disintegration piperidic to - you are (GAMK) and strengthening of GABA-ergic transfer. For P.'s most the page was not succeeded to establish connection between their anticonvulsive properties and influence on exchange of monoamines of a brain.
The mechanism of action of P. of page, effective at convulsiveless paroxysms, it is a little studied. By a number of criteria they significantly differ from the first group of drugs and, in particular, do not weaken the maximum electroconvulsive spasms and processes of post-stimulation simplification. The possible reason of the prevention of small epileptic seizures under the influence of an Ethosuximidum and Morfolepum is direct or indirect disturbance by these drugs of function of the synchronizing structures of rostral departments of a brain, first of all intralaminarny kernels of a thalamus.
For rational therapy by means of P. the page needs to meet a number of conditions. First of all the correct selection of drug depending on a form of epilepsy is necessary. At big attacks of epilepsy use phenobarbital, a hexamidine or dipheninum more often in the beginning. Doses of these drugs gradually raise to the termination of attacks or the greatest possible management of them. Control of P.'s maintenance of page in blood serum is necessary. It allows to select a minimal effective dose of drugs. Thereby it is possible to lower a daily dose and at the expense of it to reduce the frequency of emergence of side reactions and their weight. In case of resistance to any drug reasonablly combined treatment with simultaneous or consecutive use of two or more P. of page. Replacement of one drug with another shall be made by gradual reduction of a dose of earlier administered drug and transition to new P. of page in the increasing doses. At the same time it is necessary to consider pharmacokinetic interaction of different P. of page.
At most of patients with epilepsy medicinal therapy is applied for many years, and sometimes during all life. At the high-quality course of a disease, the treatment and the correct selection of P. of page early begun approach of permanent remission is possible. In some cases even practical recovery is possible. It is necessary to make P.'s cancellation by the village gradually, t to. the sudden termination of treatment can cause increase of attacks up to development of the epileptic status.
As a contraindication to use of most of P. of page serve diseases of a liver, kidneys and the hemopoietic bodies.
See also Anticonvulsants .
Bibliography: Arushanyan E. B. Cellular mechanisms of effect of antiepileptic substances, Zhurn. neuropath, and psikhiat., t. 69, No. 11, page 1731, 1969; Mashkovsky M. D. Pharmaceuticals, p.1, M., 1977; Antiepileptic drugs, Quantitative analysis and Interpretation, ed. by C. E. Pippenger and. o., N. Y., 1978; Buchthal A. Zur Pharmakotherapie der Epilepsien, Med. Welt, S. 919, 1978; Richens A. Antiepileptic drugs. in book: Recent Advanc. Clin. Pharm., ed. by P. Turner a. D. G. Shand, No. 1, p. 147, Edinburgh and. o., 1978, bibliogr.
E. B. Arushanyan, A. I. Boldyrev.